Five Florida Hospitals Sue Safety Ratings System

Medscape

28-05-2025

Five Tenet Healthcare hospitals are suing a leading provider of hospital safety ratings in federal court, alleging that it 'pressures hospitals to participate and pay or else suffer devastating and misleading public 'safety' grades.'
The South Florida hospitals all got 'D' or 'F' grades in the fall 2024 ratings from Leapfrog Group's Hospital Safety Grade website after they declined to answer the company's surveys. The hospitals also received poor overall and patient-satisfaction ratings from Medicare.
Leah Binder, Leapfrog's president and CEO, told Medscape Medical News that the nonprofit organization stands by its ratings. 'The Tenet Healthcare system has disgraceful performance on patient safety,' she said, 'and that is what they should be spending their money to address.'
The legal battle pits Tenet Healthcare, which made a net $20.7 billion in revenue last year, against a nonprofit with a recent annual revenue of just $7.6 million but significant influence over hospital reputations.
Methodology Under Fire
At issue: Should hospitals be punished when they decline to provide data for Leapfrog's safety ratings?
Until recently, Leapfrog gave average scores on several measures to hospitals that refused to respond to surveys. The organization changed course as of the fall 2024 ratings and now automatically gives the lowest rating possible to nonparticipating hospitals on four of 30 measures — Computerized Physician Order Entry, Bar Code Medication Administration, Intensive Care Unit Physician Staffing, and Hand Hygiene Score.
As a result, nonparticipating hospitals get worse safety ratings because their scores on these measures count toward their overall letter grades.
Among the five hospitals that are suing, Good Samaritan (West Palm Beach), Delray (Delray Beach), and Palm Beach Gardens got 'F' grades. West Boca (Boca Raton) and St. Mary's (West Palm Beach) got 'D' grades. The lawsuit, filed on April 30, said the hospital stopped responding to Leapfrog's 'excessive' data requests in 2021.
The hospitals contended Leapfrog 'relies on invented data for some hospitals but not others.'
The lowest-possible rating (15/100) for handwashing at the Delray hospital, for example, is 'deceptively communicating to consumers that Delray Medical Center doctors and nurses don't adequately wash their hands, among other false statements — with no data whatsoever to support that conclusion.'
Binder defended the change in methodology. 'We continuously received complaints from hundreds of hospitals that do report to the survey,' she said.
An expert panel recommended a move toward standardized low scores for nonparticipating hospitals, she said, and Leapfrog changed its methodology.
Ratings System Says It's Being Transparent
Binder said Leapfrog, founded 25 years ago by employers and others seeking better hospital safety information, is open about its data and methods. Leapfrog uses patient satisfaction survey data that are used, in part, to determine physician compensation, raises, and bonuses.
'It's pretty easy for us to defend the responsibility with which Leapfrog issues these grades,' Binder said. 'Even if, for some reason, we felt like we wanted to show bias towards some hospital or against another hospital, it would be really hard to do that when we're putting the entire methodology out there.'
According to Leapfrog, refusing to participate in the company's surveys isn't a ticket to a poor grade. About 20% of 2829 hospitals rated in the Spring 2025 Hospital Safety Grades report didn't respond to surveys, the company said in response to queries from Medscape Medical News . Among those, six got an 'A,' 20 got a 'B,' 380 got a 'C,' 167 got a 'D,' and 19 got an 'F.'
Leapfrog described its methodology regarding the four measures in small print at the bottom of webpages that report individual hospital safety grades. See, for example, the Palm Beach Gardens hospital's ' handwashing' page on the Hospital Safety Grade website.
'I don't think it's that fine of print,' Binder said. 'If you're digging into it, you're going to see that we make it clear.'
'Self-Reported, Biased, and Subject to Manipulation'
The lawsuit also claims that data provided by participating hospitals 'is self-reported, biased, and subject to manipulation.'
Binder responded that self-reported data goes through an 'intensive verification process,' including on-site verifications at randomly selected hospitals each year.
However, a 2019 New England Journal of Medicine Catalyst report noted that 'Leapfrog leadership stated that they had only done a formal audit for approximately five hospitals of about 2600 in the past year, and only 72 hospitals underwent an electronic audit.'
The rate-the-raters report graded hospital quality ratings systems and gave a C to the Medicare system and a C-minus to Leapfrog. The US News & World Report grading system received a B, and Healthgrades got a D-minus.
In the new lawsuits, the 5 hospitals also claim that Leapfrog 'has used the tens of millions of dollars of revenue it has collected from participating hospitals and other sponsors in its pay-to-play system to pay exorbitant salaries to its owner and executives. Between 2019 and 2023, [Leapfrog] has paid over 3 million dollars in salary and benefits to Leah Binder — its CEO.' 'Hospitals, researchers, and businesses can license Leapfrog data for a fee. This has no influence on ratings…,' Leapfrog said in a statement.
The CEO of Tenet Healthcare, the owner of the five hospitals that are suing, made $24.7 million in compensation in 2024, according to Becker's Hospital Review.
Hospitals Tout Performance but Ignore Federal Ratings
The lawsuit described the five South Florida hospitals as award-winning and 'high-performing' with 'reputations for being high-quality healthcare systems that put patient care first.'
However, the lawsuit failed to mention that the hospitals all received low scores from Medicare's hospital comparison tool. On a 5-star scale, Good Samaritan and St. Mary's have 1-star overall and patient-satisfaction ratings. Palm Beach Gardens has 1- and 2-star ratings on the measures, respectively, while West Boca and Delray have 2- and 1-star ratings, respectively.
Their scores are 'among the worst in the country,' Binder said. 'They are performing extremely poorly in the eyes of their own patients.'
The hospitals declined to speak on the record about the lawsuit or answer questions regarding their poor ratings under Medicare's grading system.
In a statement to Medscape Medical News , they said, 'our hospitals are continuously working to improve the patient experience and have been recognized repeatedly for our leadership in quality, innovation, and compassionate care.'
Legal Expert: Facts, Not Grades, Are Key
How vulnerable is Leapfrog in court? Eric Goldman, JD, MBA, a professor at California's Santa Clara University School of Law, Santa Clara, California, who has studied online rating systems, said this case is different than a filmmaker suing a movie critic over a bad review.
'When it comes to something like hospitals, the consequences [of ratings] are much higher,' he told Medscape Medical News . 'You watch a bad movie, you lose 20 bucks and 2 hours of your time. You go to the wrong hospital, you might be dead.'
Goldman suggested the legal issue isn't the grades themselves — which are opinion and therefore protected under the First Amendment — but whether Leapfrog is following its own rules.
'The legal question is whether, by stating a methodology and then failing to follow it, Leapfrog is publishing false information,' he said. 'What's made it false isn't their grade but the fact that the grade is a product of reliance upon inaccurate data or the failure to process that data in accordance with their stated policies.'
He elaborated, 'I don't think that if Leapfrog assigns a hospital an 'F' that it would have the basis to sue. It might not be a credible grade, but it's still not actionable. But if they're reporting that the hospitals are not performing on certain criteria, that's the potential fact claim that could be the basis of a lawsuit.'
According to Goldman, Leapfrog's strongest defense may be the market itself.
'Leapfrog is absolutely free to assign a grade however it wants. That is its prerogative, and that's constitutionally protected as an opinion,' he said. 'Ultimately, the market decides how credible they find Leapfrog's methodology. If people find it credible, they continue to use it. If they don't, they're not required to.'